Ebola 2.0 – Lessons Learned in 2014 May Not Suffice

As the number of suspected Ebola cases in the secluded Bas-Uélé region of the Democratic Republic Congo keeps rising, it remains unclear whether the international community is capable of effectively handling this second outbreak. Health workers are currently monitoring more than 400 people in the region affected, and three deaths have already occurred. The DRC’s health minister, Oly Ilunga Kalenga, has declared the country is dealing with a “national health emergency with international significance”. But will the international community be able to show it has learned its lessons and muster a better response than it did in 2014?

The 2014 Ebola epidemic claimed more than 11,000 lives in West Africa and was perhaps the deadliest human security disaster of the 21st century. But what was even more shocking than the dramatic loss of life was the ineptitude of the international community, which greatly enabled the spread of the diseases. The virus, normally endemic to Western Africa, spread to cause deaths in six countries, including the United States, before finally being contained in 2016.

Denial is not just a river in Egypt

Critics pointed to the World Health Organization’s slow response to the budding crisis. Long weeks passed before the WHO did anything other than turning a blind eye to the rapid spread of the virus and issuing denials. Indeed, while the first cases were reported in April, the organization waited until August to declare a public health emergency. The fact that WHO country offices in Africa were staffed with politically motivated appointees that had no clue of public health policies didn’t help the organization either.

A panel of 19 experts convened to conduct the post-mortem of the outbreak lambasted the WHO, calling its response an “egregious failure”. This assessment was echoed by other health professionals such as Dr. Terence Gibson, who claimed that the WHO’s management of the outbreak was slowed down by “systemic failure at the highest level of the organization”.

Sadly though, despite the scathing lessons of 2014-2015, the WHO doesn’t seem ready to cope with another Ebola epidemic of similar scale. In a dramatic display of irresponsibility, the 2016-2017 budget actually slashed the already paltry “outbreak and crisis response funding” from $227 million to $204 million – out of a budget of $4.4 billion that goes mostly to non-communicable diseases such as substance abuse. While few expect the current outbreak to attain the magnitude seen three years ago – due to the fact that the Bas-Uélé province is very remote, with poor road infrastructure and low mobility between towns – the overall competence of the WHO remains a burning question.

Now, health professionals are holding faith in a new Ebola vaccine developed by Merck, which has proved successful in clinical trials. In December 2016, the respected British medical journal The Lancet reported the shot to be 100% effective, after researches conducted a study on 11,841 residents of Guinea, half of which received the rVSV-ZEBOV vaccine. Currently, the shot is still awaiting authorization and has yet to be requested by DRC authorities.

Much like the WHO however, the efficiency of the new vaccine has been called into question. In April, the US National Academy of Medicine criticized the methodology of the initial trials, stating that the protection offered by the vaccine “could in reality be quite low.” Indeed, the vaccine has not been adequately tested on children, pregnant women, or individuals with HIV. In the worst-case scenario, it could prove both unsafe and inefficient. Moreover, the Merck vaccine has been developed to target only a particular strain of Ebola, a virus noted for its ability to mutate. And it will certainly not be a long-term solution to the recurring Ebola problem in West Africa.

Adding insult to injury, while the WHO currently has 300,000 doses of the experimental vaccine ready for emergency use, the very composition of the vaccine is not suitable for long-term immunization campaigns. Marie-Pierre Preziosi, medical officer of the Initiative for Vaccine Research at the World Health Organization says that unlike the vaccine for polio or smallpox, Merck’s rVSV-ZEBOV shot can’t be administered as a preventive vaccine as there’s not enough data to show for how long an immunized person would actually be protected from the virus.

How do you solve a problem like Ebola?

Instead of looking to the WHO and Merck’s vaccine, the international aid community should provide a more sustainable response that would start by strengthening Africa’s healthcare sector through foreign investments and public private partnerships. When the 2014 epidemic begun, Liberia only had 51 doctors for a country of 4 million strong – had there been adequate healthcare infrastructure in place, the epidemic would not have become such a large-scale tragedy. By contrast, neighboring Guinea managed to contain the disease quicker, largely thanks to massive investments from Russia’s Rusal, which received accolades from the WHO for building a hospital and microbiological research center in the Kindia region. The facility was partially used by Russian scientists to develop an alternative vaccine, which will be tested this summer.

But simply building infrastructure is not enough – local populations need to be educated on preventive care, a complicated feat that would entail changing cultural traditions and social structures. The WHO estimates that 60% of Ebola cases in Liberia and Sierra Leone were linked to traditional burial rites. In the two countries, some social groups actually require mourners to bathe in or anoint others with rinse water from the washing of corpses.

All of these debates are unfolding against an auspicious backdrop. The current Director General of WHO, Dr. Margaret Chan, will step down later this year and elections will be held at the end of May. Chan has held the position for the last decade, making her departure the end of an era for the organization. Whomever gets the position will need to take drastic reforms to purge itself from the failures of 2014. Otherwise, history will just keep repeating itself.

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